Testosterone is often associated with masculinity and strength, but it holds the key to fertility. The road to fatherhood becomes uncertain when vital hormone drops too low. Around 2 to 4% deal with the issue of low testosterone because of the issue with the biological rhythm of the body. One of the overlooked issues is Hypogonadotropic hypogonadism, which most men don’t even know about. Although the ratio is 1:10,000, having awareness can protect from the issue.
Through this article, Aveya Fertility Centre wants to decode what hypogonadotropic hypogonadism is, how it impacts male fertility, and leads to infertility.
What is hypogonadism?
When the body is unable to produce enough testosterone, the problem starts in the testicles. In this, the body tries to stimulate the testes but is unable to respond, resulting in hypogonadism.
What is Hypogonadotropic hypogonadism (HH)?
Low testosterone is also known as Hypogonadism, but when it turns out to be secondary hypogonadism, then this specification is called Hypogonadotropic Hypogonadism (a form of secondary hypogonadism). 99% of total testosterone in the male body is synthesized in Leydig Cells, and if a defect or interference in these cells occurs, the issue started to begins. When the body is unable to produce enough testosterone because of an issue with the pituitary gland or the hypothalamus. Moreover, in this, the brain is unable to send a signal to the brain to stimulate the testes due to low LH, FSH, and testosterone.
Biological mechanism
- The hypothalamus secretes gonadotropin-releasing hormones in a pulsatile manner.
- GnRH stimulates the anterior pituitary and releases FSH and LH.
- Testes produce testosterone when LH acts on Leydig cells.
- FSH acts on Sertoli cells and supports sperm production.
- Inhibin B and testosterone help to make this process in a loop.
How does it impact male fertility?
Testosterone alone is not enough to become a father. A combination of LH, FSH, Sertoli, and Leydig cells is required, and they should not remain dormant and halt spermatogenesis. As per NIH research, 4.1% of men between 40 to 49 and 9.3% of those aged 60 to 70 have Hypogonadotropic hypogonadism. Let’s understand how Hypogonadotropic hypogonadism (HH) impacts male fertility-
- Disrupt spermatogenesis
The foundation of sperm production got disrupted because, in this condition, the hypothalamus and pituitary gland are unable to produce enough FSH, LH, and GnRH, which miss the signals in HH. This makes the testes unable to initiate and maintain normal spermatogenesis.
- Decrease testosterone level
A deficiency of LH hormones impacted the production of testosterone in both the bloodstream and within the testicles. Low testosterone doesn’t always cause infertility. Because of the disrupted spermatogenesis, infertility chances increase. Globally, 2% to 5% (between 82 to 207 million) men are dealing with infertility because of HH.
- Underactive serotonin cells
Sertoli cells play a crucial role in spermatogenesis, which helps in the process of sperm cell development. But due to a deficiency of Luteinizing hormones and follicle-stimulating hormones issue called underactive Sertoli cells can occur, which ultimately impacts the production of sperm, leading to infertility.
- Low intratesticular testosterone
This issue occurs when the testicles are unable to stimulate because of the lack of hormones, like Leydig cells in the testes, and reduced testosterone. In this, the major problem occurs between the signal pathways of the brain to the testicles.
Contigental Hypogonadotropic Hypogonadism
The fertility outlook for untreated HH is poor, and natural conception chances are only 5%. Men with contigental HH like Kallmann Syndrome unable to go through natural puberty, and this signs in the form of crytorchodism (undescended testicles), micropenis, absent of pubic hair, and underdevelop phycial features. It also causes anosmia (genetic mutation impacts the migration of GnRH-producing neurons), generates abnormalities in testicular development, and creates sexual dysfunction.
While in adults, it is characterised by inadequate production of FS (follicle-stimulating) and LH (luteinizing hormone). This leads to the absence of sperm in the ejaculation (azzospermia). Also, hormonal deficiency in the Hypogonadotropic Hypogonadism affects the motility of sperm, which further unable to fertilizing the egg.
Causes
- Damaged pituitary gland or hypothalamus, either because of trauma, injury, tumor, or incident.
- Genetic defects (Kallmann syndrome, Prader-Willi syndrome, congenital GnRH deficiency, etc), severe stress, or use of drugs.
- Rapid weight loss leads to nutritional issues.
- Medical conditions like iron overload.
- High levels of proclatin level which are released from the pituitary.
Symptoms
Here are some of the signs that a man should not ignore:
- A decrease in sexual desires and an inability to maintain or achieve an erection.
- Lack of energy and feeling fatigued throughout the day.
- Strength and muscle mass start to decrease because low testosterone is unable to perform its role in muscle development.
- Fat deposition around the stomach area started to increase.
- In some of the cases, men experience breast enlargement (gynecomastia).
- Hair growth reduces.
- Low testosterone increases the risk of fracture because of the low bone density.
Diagnosis
Hypogonadotropic hypogonadism can be diagnosed at any age, though it is often suspected during or after puberty; sometimes, it can be detected in childhood.
- Clinical assessment: by analysing the medical history of the patient, through physical examination, like evaluating the signs of delayed puberty or androgen deficiency.
- Laboratory testing: blood test helps to measure FSH, LH, testosterone, prolactin, and TSH levels. Sometimes, a GnRH (gonadotropin-releasing hormone) stimulating test is also conducted.
- Genetic testing: This is mainly done when the patient is suspected to have Kallmann syndrome or has another genetic issue in the form of HH.
- Imaging: through MRI, doctors analyze the brain, pituitary gland, and hypothalamus. This helps to know whether the patient has any abnormal structure or tumor, which results in the form of hypogonadotropic hypogonadism.
Treatment options
- Testosterone replacement therapy:
This helps in raising the level of testosterone and improves the symptoms of the issue. There are several methods that are administered as per the patient’s condition, and this includes-
- Oral testosterone medications are recommended by doctors to fulfill the need for hormones.
- Buccal tablets- these are applied to the gum, and this allows the body to absorb the testosterone into the bloodstream.
- Subcutaneous pellets- these are placed under the skin for more sustainability. This releases the testosterone hormones in the body for several months. Throughout the time, doctors advised patients to visit the clinic so they could measure the level of hormones.
- Transdermal patches or gel- these are just like a lotion, which is applied directly on the skin to allow the body to absorb the hormone.
- Injection- This is an intramuscular injection, which is directly injected into the muscle. Don’t consider doing it by yourself. It is better to consult with your doctor and know how much dose, where, and at what time these injections need to be administered.
- Gonadotropic therapy:
This method typically involves injection and aids in stimulating the testicles to produce sperm and testosterone. Medications like hCG (human chorionic gonadotropin), hMG (human menopausal gonadotropin), and rFSH (recombinant FSH) are given to the patients.
- Addressing underlying conditions:
If the issue is caused by the tumor, then surgery is involved along with radiation therapy. Sometimes, injuries or illness also contribute to the result in the form of hypogonadotropic hypogonadism.
- Additional treatments:
GnRH (gonadotropin-releasing hormone) is injected to stimulate the pituitary gland by releasing FSH and LH. Also, a medication like Clomiphene Citrate is considered to role a similar role as GnRH, and these are used as an alternative to gonadotropins.
But it is strictly advised to consult with the expert before consuming any medication, as it will help you to being impacted because of medications.
Emotional and psychological impact
Some studies revealed that 35% to 50% of men with HH have depressive symptoms. While young patients tend to display the signs of difficulty in emotional roles. This emotional toll not only impacted their daily life, but it also decreased libido in 40%, caused erectile dysfunction in 32% and orgasmic disorder in 35%.
Conclusion
There is nothing that cannot be treated unless you take the right step before making it worse. Unusually, men ignore the signs of health issues, which further lead to many issues like infertility. A small percentage of the male population knows about HH only because of a lack of knowledge and awareness. Our body plays on mechanisms, and this indicates the issue before it actually starts to hit like a rock.
Hypogonadotropic Hypogonadism is not an issue of hormonal imbalance-It’s a silent disruptor of fertility. Timely diagnosis can reverse the issue by restoring the hormones.
That is why doctors said that early diagnosis is the key to resolving the issue effectively. We know you might have a lot of queries related to HH, that is why Aveya Fertility Centre is available 24*7 for you.
If you have any queries or want to have legitimate information, you can contact us and book your appointment now!
